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T Karamfilov

Publications and source records attributed to T Karamfilov.

14 recordsLinked to original sources
PubMed2003

[Pansclerotic porphyria cutanea tarda after chronic exposure to organic solvents].

A 63 year old man developed generalized scleroderma with massive sclerotic areas, particularly in the abdominal region, four years after being diagnosed with porphyria cutanea tarda (PCT). He had almost daily exposure to organic solvents (benzene, trichlorethylene) for many years. The cutaneous fibrosis progressed dramatically leading to a pansclerosis, even though the uroporphyrin levels were borderline and the liver enzyme values were normal. Organic solvents are among those substances which can cause a cutaneous fibrosis. The unusually complicated clinical development in our patient was a combination of the two initial factors, the PCT and the long term exposure to organic solvents. The pansclerotic PCT was differentiated from a systemic sclerosis, a disabling pansclerotic morphea and a generalized morphea by means of histological examinations, the absence of a Raynaud phenomenon and the non-involvement of additional organs. Auto-antibodies typical for systemic sclerosis were negative. Using a medium dosage of UVA1 phototherapy and intensive physiotherapy, the progression of the skin disease was stopped and the sclerosis improved.

Alkanes↗
PubMed2002

[Sports as a risk factor and therapeutic principle in dermatology].

Sporting activities may exert positive and negative health effects. This applies not only to the cardiovascular and musculoskeletal system, but also to skin. During sporting activities a person is exposed to environmental factors such as temperature, irradiation, and allergens. These factors may play a key role in the development of skin diseases. Mechanical trauma is caused by acute injury as well as chronic damage. Infectious skin diseases caused by viruses, bacteria or fungi can be transmitted by body contact or the use of communal showers or locker rooms. Intake of performance-enhancing substances may provoke skin changes such as striae distensae, androgenetic alopecia, hypertrichosis and acne. Preexisting skin diseases such as psoriasis, lichen planus, vitiligo, polymorphous light eruption, lupus erythematosus, porphyria, urticaria, and acne rosacea may be aggravated by sporting activities. On the other hand, physical exercise has a therapeutic potential which has hardly been exploited by dermatologists. Especially in chronic skin diseases positive effects have been observed. Therapeutic use of team sports has been shown to decrease suffering, depression, and emotional disturbances and increase life quality in patients with atopic eczema, psoriasis, and venous leg ulcers.

Combined Modality Therapy↗
PubMed2002

Adjuvant botulinum toxin A in dyshidrotic hand eczema: a controlled prospective pilot study with left-right comparison.

OBJECTIVE: Dyshidrotic hand eczema is a therapeutic challenge. A prospective pilot study was performed with left-right comparison in order to investigate whether chemical de-innervation of sudoriferic nerves would be superior to standard therapy with topical corticosteroids. BACKGROUND: Botulinum toxin A (BTXA) is a potent inhibitor of acetylcholine release, that induces eccrine sweat production and release. Inhibition of sweating by other measures such as tap water iontophoresis has been shown to be beneficial in dyshidrotic hand eczema. METHODS: Eight adult patients suffering from dyshidrotic hand eczema (atopic type) were included in a prospective, side-by-side controlled clinical pilot study using topical corticosteroids on both hands in combination with intracutaneous injections of 100 units of BTXA (Botox) on the more severely affected hand on day 1. The dyshidrotic hand eczema was classified using the DASI (Dyshidrotic Eczema Area and Severity Index) before treatment (0), after 1 week, 4 weeks and 8 weeks. RESULTS: Six patients completed the study, two dropped out because of social and personal reasons. The mean DASI score changed from 28 to17 with topical therapy alone and from 36 to 3 with adjuvant BTXA (P < 0.01). Itching and vesiculation were inhibited earlier when using the combination of corticosteroids and BTXA. There was one relapse in the corticosteroid group. Relapses have not been seen in the BTXA group. CONCLUSIONS: Interruption of sweating by BTXA improves the outcome and reduces relapses in patients with dyshidrotic hand eczema. BTXA is antipruritic as well suggesting that it does not only interact with acetylcholine release but substance P.

Adult↗
PubMed2001

Botulinum toxin A for palmar hyperhidrosis.

OBJECTIVE: We evaluated the efficacy and safety of intracutaneous injections of botulinum toxin A on severe palmar hyperhidrosis. METHODS: Ten patients with recalcitrant palmar hyperhidrosis were treated with intercutaneous injections of botulinum toxin A (Botox; 200 U for each hand). Patients were followed up to 23 months (mean +/- SD: 12.1 +/- 6.2 months). RESULTS Botulinum toxin significantly reduced abnormal sweating within 1 week in 100% of the patients. In six patients with a follow-up of 12 months or more the antisudorific effect lasted 12.3 +/- 5.5 months. The longest response duration was 22 months. Repeated treatment was performed in five patients with unchanged clinical efficacy. The only side-effect was tolerable pain from the intracutaneous injections in patients where a nerve block was not performed. CONCLUSIONS: Botulinum toxin A (200 U Botox per palm) was able to induce long-term remission in palmar hyperhidrosis without significant acute and long-term side-effects. Strictly intracutaneous injection of small volumes is recommended. So far, response to repeated treatments did not show evidence of neutralizing antibody induction.

Adult↗
PubMed2001

Treatment of common warts and actinic keratoses by Er:YAG laser.

BACKGROUND AND OBJECTIVES: The use of ablative lasers in the treatment of common warts and precancerous actinic keratoses has been reported in the literature, showing variable response rates and relapse rates. The erbium:YAG laser (Er:YAG) with a wavelength of 2.94 microm allows precise ablation avoiding strong inflammation. The authors have evaluated the potential benefits of Er:YAG laser treatment for difficult-to-treat warts and actinic keratoses. PATIENTS AND METHODS: A total of 69 patients with difficult-to-treat warts (periungual or plantar) with a mean age of 30.1 +/- 16.1 years (range 11-58 years), and 29 patients with actinic keratoses with a mean age of 73.5 +/- 9.7 years (range 58-90 years) were treated by Er:YAG laser. Ablative therapy was performed with a spot size of 3 mm, a frequency between 8 Hz and 15 Hz, and a fluence of 5.7-11.3 J cm(-2) (warts) or 5.7-7.1 J cm(-2) (actinic keratoses). RESULTS: After a single laser treatment a complete response (CR) was observed in 50 patients with warts (72.5%). Plantar warts were more resistant (13.5% non-responder) compared with periungual warts (5.9% non-responder). Twelve patients with a CR showed a relapse within 3 months after treatment (24.0%). All but one suffered from plantar warts. Twenty-six patients with actinic keratoses showed a CR after a single laser treatment, and in three patients a partial response (PR) was achieved. None of the patients treated with Er:YAG laser developed pigment changes, wound infections or scarring. CONCLUSION: Treatment of common epithelial lesions such as common warts or actinic keratoses by Er:YAG laser is safe and effective. In patients with plantar warts, however, a significant rate of relapse may occur, requiring additional therapy.

Adolescent↗
PubMed2001

Intracutaneous botulinum toxin A versus ablative therapy of Hailey-Hailey disease--a case report.

BACKGROUND: Hailey-Hailey disease is an autosomal-dominant blistering disease affecting the intertriginous skin. Dermabrasion and ablative laser treatment are known to be curative. Sweating is a common aggravating factor. Botulinum toxin A (BTXA) has been shown to inhibit sudoriferic nerves. OBJECTIVE: To evaluate whether a treatment with BTXA induces remissions and can compete with ablative therapy. To compare dermabrasion with erbium:YAG laser therapy. METHOD: Case report with side-by-side comparison. We used intracutaneous BTXA on both sides of the submammary region. Four days later a limited area of 25 cm(2) on each side was treated with either dermabrasion or erbium:YAG laser. The follow-up was 12 months. RESULTS: Wound healing was complete within 7 days after erbium:YAG laser and two weeks after dermabrasion. Areas treated with BTXA alone also showed complete remission within two weeks. During a follow-up, no relapse occurred with either treatment. CONCLUSION: BTXA is capable of inducing remissions of Hailey-Hailey disease without abrasion for at least 12 months. Among ablative treatments, erbium: YAG laser therapy leads to a more rapid wound closure than dermabrasion, with both causing complete remissions.

Botulinum Toxins, Type A↗
PubMed2000

Lower relapse rate of botulinum toxin A therapy for axillary hyperhidrosis by dose increase.

BACKGROUND: Primary focal hyperhidrosis is a common condition that gives rise to functional and emotional problems and may disturb professional and social life. Recently, low-dose intracutaneous injections of botulinum toxin A have been shown to induce a temporary anhidrosis, with relapses occurring usually after 4 to 6 months. OBJECTIVE: To evaluate the short- and long-term effectiveness and possible adverse effects of high-dose botulinum toxin therapy in the treatment of axillary hyperhidrosis. DESIGN: In an open study, patients with focal hyperhidrosis were treated with intracutaneous injections of botulinum toxin A (Botox; Allergan Inc, Irvine, Calif). A total dose of 200 U of botulinum toxin A was used once per axilla. Patients were observed for up to 15 months. SETTINGS: University medical center. PATIENTS: Twenty-four patients with axillary hyperhidrosis were treated. Their ages ranged from 19 to 58 years (mean +/- SD, 34.8 +/- 12.4 years). MAIN OUTCOME MEASURES: Reduction of sweating as assessed by the Minor iodine-starch test and planimetry of hyperhidrotic areas. Patients were interviewed at the end of follow-up about their satisfaction with this treatment. RESULTS: Within 6 days, all patients reported cessation of excessive sweating. The mean +/- SD area of excessive sweating identified by the Minor iodine-starch test decreased from 19.27 +/- 11.95 cm2 to 0.25 +/- 0.61 cm2 (P<.001). The mean follow-up was 10.0 +/- 2.8 months (range, 5-15 months). Four patients (17%) reported a return of axillary hyperhidrosis after 7 to 10 months. All patients who experienced relapse showed an excellent response to a second treatment. The only adverse effects reported were temporary pain and burning during the injections. No muscular weakness, insensitivity, or systemic reactions were observed. CONCLUSIONS: High-dose botulinum toxin A seems to be as safe as low-dose botulinum toxin A in the treatment of axillary hyperhidrosis. The preliminary data suggest a lower rate of relapse.

Adult↗
PubMed2000

Treatment of recalcitrant ulcers in pyoderma gangrenosum with mycophenolate mofetil and autologous keratinocyte transplantation on a hyaluronic acid matrix.

Pyoderma gangrenosum sometimes takes a recalcitrant course that is unresponsive to standard immuno-suppression with corticosteroids and/or cyclosporin A. In these cases improvement of painful ulcerations is a therapeutic challenge. We report a 17-year-old boy with severe pyoderma gangrenosum treated successfully with mycophenolate mofetil and autologous keratinocyte transplantation using an esterified hyluronic acid delivery system.

Adolescent↗
PubMed2000

Effects of adjuvant interferon-alpha low-dose therapy in melanoma patients on serum inhibin B.

Because the primary aim of adjuvant therapy for melanoma is not curative, all the possible aspects of quality of life have to be considered. One aspect of increasing importance is fertility. The effect of adjuvant interferon alpha-therapy for malignant melanoma on male fertility has not been systematically investigated. In the present study, twelve male patients with primary cutaneous melanoma (pT3, 4; N0; M0) who were taking adjuvant low-dose interferon alpha2b (3 x 3 mio U/week) for one year were included. Inhibin B--an established marker of male fertility-was measured with an immunosorbent assay before and after one year of interferon alpha-therapy to investigate whether this treatment has any influence on fertility. The results were compared with those from normal controls (n=40). The mean serum inhibin B concentration in melanoma patients before interferon therapy was 225.4 +/- 112.5 pg/mL; after treatment the level was 229.6 +/- 82.0 pg/mL. This difference was not statistically significant (p>0.05). The serum inhibin B concentration in controls was 201.5 +/- 17.1 pg/mL, which was not statistically different from either untreated or interferon-treated melanoma patients (p>0.05). We conclude that low-dose interferon alpha does not have a significant (negative) effect on inhibin B or male fertility.

Adult↗
PubMed1998

Mapping of T-cell epitopes of Phl p 5: evidence for crossreacting and non-crossreacting T-cell epitopes within Phl p 5 isoallergens.

BACKGROUND: Group 5 allergens represent major grass pollen allergens because of their high sensitization indices. The identification of T-cell epitopes of these allergens is a prerequisite for the design of immunotherapeutic strategies based on peptide vaccination or modified allergens with conserved T-cell epitopes. OBJECTIVE: This study was undertaken to determine T-cell epitopes on Phl p 5 major pollen allergen of timothy grass (Phleumn pratense). METHODS: T-cell lines (TCLs) and T-cell clones (TCCs), specific to Phl p 5, were established from the peripheral blood of 18 patients allergic to grass pollen. All TCCs were mapped for epitope specificities using 178 overlapping dodecapeptides representing the primary structures of two isoforms of Phl p 5 (Phl p 5a and Phl p 5b). Phenotype and cytokine production profiles of TCCs were tested. Selected TCCs were analysed for HLA class II restriction. RESULTS: A total of 82 TCCs were isolated. All TCCs displayed the helper cell (TH) phenotype. Their reactivity with two recombinant expressed isoforms of Phl p 5a and Phl p 5b was heterogeneous. The epitope specificity of the TCCs was then revealed. Nineteen T-cell epitopes could be identified on Phl p 5. Eighty-one percent of mapped TCCs recognized three T-cell reactive regions on the Phl p 5 allergen. Some TCCs were reactive with isoepitopes presenting on Phl p 5a as well as Phl p 5b. Allergen-specific stimulation induced a TH0-like type of cytokine production in 25 of 50 TCCs. Almost all TCCs secreted high concentrations of interleukin-13. CONCLUSION: Phl p 5, a major grass pollen allergen, contains several T-cell epitopes. Some epitope regions were recognized by several patients. Epitope recognition pattern could not be correlated with special HLA class II haplotypes. T-cell stimulating isoepitopes were found at corresponding regions of Phl p 5a and Phl p 5b isoforms.

Adult↗
PubMed1994

Analysis of human T cell clones reactive with group V grass pollen allergens.

Twenty-seven T cell clones (TCC) reactive with group V allergens of Phleum pratense (Phlp V) were established from the peripheral blood of 3 patients allergic to grass pollen. Twenty-four TCC showed the helper cell phenotype CD3+, CD4+, CD8-; the remaining clones were CD3+CD4-CD8+. T cell recognition of Phlp V was exclusively HLA-DR restricted. Many of the Phlp V reactive TCC (19 of 27; 70%) were stimulated additionally by other group V allergens isolated from Lolium perenne, Poa pratensis, and Dactylis glomerata. These data indicate the existence of cross-reacting T cell epitopes among group V allergens of different grasses. The Phlp V triggered cytokine production demonstrated in 13 out of 24 CD4+ TCC a Th2-like pattern (high interleukin 4/gamma-interferon ratios) suggesting group V allergens as important targets of grass pollen specific IgE.

Adult↗